Regular Talk About Irregularity: What to Do When You Can’t Go

Referred to politely as “irregularity,” constipation happens to all of us once in a while. If you’re being treated for breast cancer, you might have it more often. Chemotherapy, hormonal therapy, some targeted therapies, and many pain medicines are known to cause constipation. You also may have constipation alternating with diarrhea. But whether you’re constipated a couple times a year or once a week, struggling to have bowel movements is uncomfortable and stressful.

Constipation can be frustrating because many things can cause it. Besides certain breast cancer treatments and pain medicines, just getting older increases the risk of occasional constipation. Other factors that can lead to constipation include:

being anxious or in pain

disruptions in your daily routine

being inactive

dehydration or not drinking enough water

not eating enough fiber

being away from home

Air travel or specific foods (such as bananas, cheese, or milk) sometimes trigger the problem.

In some cases, the stool may be stuck in the rectum. Hard stool that won’t come out is called an impaction. Impaction may happen because the rectum is weak or stretched out and has lost its ability to sense fullness and trigger a contraction (which is necessary to expel the stool). The build-up also may be the result of the rectal sphincters (the muscles that close and open the rectum and anus) being clamped or scarred. Tightly sewn stitches after an episiotomy or a chronic anal fissure can make the anal opening too small. This can be a difficult and very painful problem.

Many women say they’ve had chronic constipation much of their lives — long before being diagnosed with breast cancer. Hemorrhoids are very common in people with ongoing constipation since straining makes hemorrhoids worse.

How do you spell relief?

Most of us turn to laxatives for constipation relief, but it can be hard to know which ones work the best and are the gentlest on the system. I also wondered if there were other ways to avoid, prevent, or ease constipation that didn’t involve a laxative. So I did some research.

As always, if constipation is a severe problem for you, make sure you talk to your doctor about it. This is especially true if you’re being treated for breast cancer or another medical condition. You want to be sure that any constipation remedy you take doesn’t interfere with your treatment. At the same time, you don’t want to harm yourself with a remedy that’s too strong. Also, in very rare cases, a serious medical condition can cause constipation, particularly if the constipation comes on suddenly. So it’s good to let your doctor know what’s going (or not going) on.

If you’re suffering from stool impaction, painful bleeding hemorrhoids, or an anal opening that’s too small, you definitely need your doctor’s help BEFORE you start treating yourself. Sometimes a disimpaction procedure is necessary. If hemorrhoids are a problem, the anal opening is too small, or the fissure won’t heal, a rectal surgeon can prescribe a conservative regimen (usually fiber and a lubricant with suppositories). If that doesn’t work, a surgical procedure may be recommended.

If you’re experiencing minor constipation, your doctor may recommend making some simple changes to your daily habits. These include always responding to the urge to go, drinking more clear fluids, eating 25 to 35 grams of fiber daily, and exercising regularly.

If you’re like me, you’re probably not sure how much fiber is in fruits and vegetables, so here’s a handy list of the top foods to eat and the amount of fiber they contain:

beans, lentils, and peanuts: 15-19 grams of fiber per cup

wheat bran: 17 grams per cup

prunes: 12 grams per cup

Asian pear: 10 grams per pear

quinoa: 9 grams per cup

raspberries: 8 grams per cup

blackberries: 8 grams per cup

Other good choices are (they all contain 2 grams of fiber):

1 cup cooked oatmeal

1 cup oat bran

1 cup collard greens

½ avocado

1 cup broccoli

1 cup Brussels sprouts

1 large sweet potato

½ cup apricots or figs

¼ cup ground flax seeds

½ cup sunflower seeds

Before going to the drug store, first give the kitchen a fair chance. I love frozen red grapes. When the organic ones are on sale, I buy a ton. Then I wash, dry, take them off the stem, and store in a freezer bag or glass jar. When I’m ready to eat them, I grab a handful, let them sit in a bowl for about a minute. Voila, they’re ready and delicious and taste like sherbet without any added sugar. Plus, they help keep me regular.

Types of laxatives

Changing your diet can help prevent constipation from happening, but if it’s already a problem, it may not help immediately. Laxatives tend to work faster and come as liquids, tablets, or capsules that are taken orally by mouth. Laxatives also can be given via the rectum as suppositories or enemas. Many brands of laxatives are available as either oral or rectal formulas. Options include:

Hydrating laxatives (osmotics) pull water from surrounding tissues into the colon. This softens the stool and increases bowel action. The most commonly recommended osmotic is polyethylene glycol (one brand is MiraLAX, which is commonly used as a prep before a colonoscopy). Other options include lactulose (one brand is Cephulac; caution: lactulose gets things moving FAST for many people) and sorbitol (available as 70% solution), which are sugars, and magnesium hydroxide (one brand is Milk of Magnesia). Some doctors suggest starting with just a daily magnesium supplement.

Stool softeners draw additional water and fats into the stool, which allows it to move more easily through the digestive tract. The most common oral stool softener is docusate, which is available in oral and rectal formulas (brand names include Colace and Surfak).

Lubricants make stools slippery so that they move more easily through the intestine. Lubricants include mineral oil and liquid paraffin. These products are not digestible; that’s how they stay in your intestines all the way through.

Stimulants trigger the intestinal muscles to contract, which makes you go to the bathroom. Options include oral or rectal bisacodyl (brand names include Dulcolax, Correctol, Feen-A-Mint) and senna, an herb (brand names include Ex-Lax, Senna X-Prep, and Senokot).

There are inexpensive products available in each laxative category, including many store brands and generics.

Many doctors recommend bulk or hydrating laxatives as the safest and most effective first choice. But which specific brand of laxative is best for you when you’re constipated isn’t always clear. If you can’t swallow pills or capsules, you can open fiber capsules and put the contents in your food. Oatmeal, apple sauce, and peanut butter are good options.

If you take a laxative:

Be aware that laxatives may take 24 to 48 hours before they have any effect on your constipation. It’s important to drink plenty of water every day even if you’re doing other things to ease constipation.

Don’t get impatient and use more than the recommended dose.

Only use laxatives for a short time. If you’re having an ongoing problem with constipation, talk to your doctor instead of continuing to treat yourself with laxatives.

When you start using a new product, you may want to make sure you stay near a bathroom. You may find that you need to go quickly.

If you use more than one product, try them at different times of the day (taken together they may be too strong). For example, take a senna product in the morning and mineral oil at night.

Laxative side effects

All laxatives, including herbals, can cause side effects. Usually these aren’t serious. The most common ones include bloating, cramping, diarrhea, nausea, and gas. More serious side effects usually only occur if you use laxatives for a long time or if you use them at doses that are too high. Here’s a breakdown of side effects by type of laxative:

Oral hydrating laxatives and oral stimulants may interfere with how your body absorbs some medications and nutrients in food (like vitamin D). They also can make you thirsty and dehydrated, and may cause an electrolyte imbalance. Electrolytes (such as calcium, potassium, sodium, and magnesium) regulate body functions such as heart rhythm, nerve function, and muscle contraction. A significant imbalance can build up over time and can cause problems such as weakness, abnormal heart rhythms, and bone loss.

Oral stimulants also may damage your intestines and lead to dependency. This means that you won’t be able to have a bowel movement without using them. This happens only if you overuse oral stimulants for a long time.

Oral and rectal emollients can reduce the amount of fat-soluble vitamins (A, D, E, and K) that the body absorbs. Your body needs these vitamins to be healthy.

Oral emollientscan cause a serious condition called aspiration pneumonitis (a form of lung inflammation) if you accidentally inhale small amounts of the laxatives.

Enemas or suppositories can damage the rectum if you insert an enema tip the wrong way or cut yourself with a sharp fingernail.

It’s important to know that overusing products for chronic constipation can make hemorrhoids worse, leading to further discomfort and even bleeding.

Alternatives to laxatives

There are several relatively simple things you can do to prevent and treat constipation without using laxatives. Here are some tips that can help you manage irregularity without using medicine:

If you know certain foods make you constipated, try to avoid them. Common problem foods include cheese, milk, meat, eggs, and bananas.

Eat more high-fiber foods, such as whole-grain breads and cereals, beans, and fresh vegetables and fruit. Cooked and dried fruits are also good choices. Fiber isn’t digested by the body, so it helps move stool through the body.

Drink plenty of water throughout the day and avoid getting dehydrated. This is especially important if you’re eating more high-fiber foods, because fiber absorbs a lot of water in the bowels (which makes stools softer and easier to pass).

Consider adding foods considered probiotics, such as yogurt, to your diet. Probiotics contain organisms such as bacteria or yeast that help digestion. Some early studies suggest that probiotics can help relieve constipation, but more research needs to be done to learn if using them as a treatment could be effective.

Try drinking a cup of coffee, which can act like a mild laxative. Other warm beverages may help stimulate a bowel movement, too. Try a cup of herbal tea, or even some hot water with a squeeze of lemon.

Exercise! I know people who say that practicing yoga has cured them of constipation. I don’t know if it works for everyone, but being active in any way certainly helps the body function better.

Try to relax. Keep in mind that you don’t need to have a bowel movement every day for good health. Try not to get anxious if it’s been a few days. Often the body takes care of itself.

Anticipate bouts of constipation and prepare ahead of time. If traveling slows you down, then get things rolling before you leave town and keep the regimen going throughout your travels. If you know you’ll have constipation with the next cycle of chemo, ask your medical oncologist or nurse what you can do ahead of time to avoid the problem.

When in doubt, consider Grandma’s constipation remedy — prunes. Research has shown that they really do work. In one study, participants who ate about seven prunes twice a day had less constipation than those who took regular doses of a bulk laxative. Using various foods as medicine throughout the day can work wonders. My favorites are papaya, pears, figs (fresh or dried), peaches, pineapple, rhubarb, celery, broccoli (or broccolini), cauliflower, carrots, Brussels sprouts, coleslaw, and kidney beans. Eggplant works well but tends to produce too much gas.

Adding lots of high fiber foods to your diet can make you feel bloated and lead to a gas problem. It’s best to introduce one extra fiber food per day (not all at once). Doing regular exercise, moving around throughout the day (getting up every 45 minutes for a short walk if you have a desk job, for example), and drinking lots of fluids can help. Cornstarch powder around the anal opening (but not around the labia/vagina), can make you more comfortable, muffle any sounds from the release of gas, and soothe irritated skin. NEVER use talcum powder; it may increase cancer risk. You can buy kitchen cornstarch or fragrance-free baby powder made only of cornstarch.

To avoid or minimize the gas problem from beans and high fiber vegetables, some people swear by the supplement called Beano. Beano contains an enzyme that helps break down high-fiber foods so your body produces less gas when digesting them.

If you have occasional or chronic constipation, which remedies work for you? Do you have solutions for gas and hemorrhoids?

Marisa Weiss, M.D. is the founder, president, and chief medical officer of Breastcancer.org, the world's most trafficked online resource for medically reviewed breast health and breast cancer information, reaching over 14 million visitors per year. A breast cancer oncologist with over twenty years of active practice in the Philadelphia region, Dr. Weiss is regarded as a visionary advocate for her innovative and steadfast approach to informing, empowering, and treating patients with breast cancer.